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General NPI Number Information
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NPI Number | 1639651714
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Entity Type | Individual
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Provider Name | IBRAHIMA T DIALLO APN
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Gender | Male
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 97 NEWKIRK ST APT 228-229
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City | JERSEY CITY
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State | NJ
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Zip | 07306-3021
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Country | US
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Telephone | 888-551-5456
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Fax | 888-305-9996
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Provider Business Mailing Address
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Address Line | 97 NEWKIRK ST APT 228-229
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City | JERSEY CITY
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State | NJ
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Zip | 07306-3021
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Country | US
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Telephone | 888-551-5456
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Fax | 888-305-9996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01390500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025070922
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License Number State | NJ
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